HRT alternatives 'could damage your health' warning

Hundreds of thousands stopped taking Hormone Replacement Therapy to relieve symptoms of the menopause after health scares and started using complementary treatments instead.

But the Royal College of Obstetricians and Gynaecologists yesterday issued an unprecedented warning saying many herbal remedies and supplements have not been properly tested and can cause serious harm.

They can interact with prescribed medications such as the blood-thinning agent warfarin and antidepressants, which may stop them working.

They say there is little evidence to show treatments such as black cohosh, red clover, evening primrose oil, ginseng and St John's wort help and could do damage in some cases.

In a new report, the RCOG said: 'Some treatments do not have sufficient scientific evidence to support their claims of relieving menopausal symptoms or of being able to equal the benefits of conventional therapies.'

Richard Warren, honorary secretary of the RCOG, said: 'The current interest and enthusiasm directed towards alternative treatments for menopausal symptoms is understandable, but the full risks and benefits of these alternatives are still unknown.

'Each case needs to be considered individually. In women with specific risk factors, a clinician should weigh up the advantages and disadvantages of alternative therapies compared to those of traditional HRT.

'Interactions with commonly used medications such as warfarin and antidepressants can cause potentially fatal results.'

Conflicting reports from US and UK researchers about the safety of HRT have led to confusion for women in recent years.

Some show an increase in the risks of breast cancer, heart disease and stroke for women taking long-term combination HRT - using oestrogen and the hormone progestogen to protect the womb.

An estimated 1.8 million British women were using HRT to relieve menopausal symptoms such as hot flushes, night sweats and loss of libido before the health scares.

But the number is believed to have halved, with many women confused about whether the health risks outweigh the benefits.

Existing guidance to doctors and patients says women should take HRT for the shortest time possible, but it is effective in combating symptoms.

The new RCOG report says alternative preparations reduce symptoms by 50-60 per cent.

This is 'considerably lower' than the efficacy of HRT which results in 80-90 per cent fewer symptoms.

However, some of the better researched preparations such as soy and red clover may have beneficial effects not only on symptoms but helping maintain bone and heart health, it says.

'Homeopathy also had encouraging results in the small scale trials that have been conducted.

But some herbal remedies contain oestrogenic compounds - plant versions that mimic the effect of the hormone oestrogen in the body - which 'may be of concern' to women with breast cancer.

'The herb black cohosh has been linked to liver toxicity and in one instance a patient subsequently required a liver transplant after a severe adverse reaction.

'There is also concern about contaminants such as mercury, arsenic lead and pesticides' says the report.

Consultant gynaecologist Nick Panay, of Queen Charlotte's Hospital, London, and co-author of the report, said 'Many women use alternatives to HRT to help control menopausal symptoms believing them to be safer and 'more natural'.

'But in many cases appropriate research into their safety has not been done.

'I'm a strong supporter of an integrated approach using lifestyle, alternatives and HRT but it must be evidence-based to confirm both efficacy and long-term safety.'

Mr Panay, who is patron of the Daisy Network which supports women going through premature menopause, said women who find their doctor lacks knowledge about treatments or is unhelpful should not put up with it.

'They should ask to be referred to a health professional who is interested and has expertise in the menopause' he added.

Nutritionist Maryon Stewart, of the Women's Nutritional Advisory Service, said the report was a step in the right direction, but 'wholly inadequate'.

She said 'It deals with diet in just a few lines when there is so much to it than that. Even the Government's own National Diet and Nutrition Surveys show many of us have nutritional inadequacies that can affect brain chemistry and hormonal function.

'There is clearly a need for more research and funding into alternative treatments which the Government should provide.

'HRT is no longer a treatment option for life - everyone agrees it should be given in the minimum dose for the least amount of time to those that suffer severe symptoms - and women are left confused.

'One of the main problems is that many doctors are inadequately trained on the alternatives to HRT and women are left to fend for themselves' she added.